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Finding a Path to Entrustment in Undergraduate Medical Education: A Progress Report From the AAMC Core Entrustable
David R Brown1, Jamie B Warren, Abbas Hyderi
1D.R. Brown is vice chair, chief of family and community medicine, and associate professor of humanities, health, and society, Florida International University Herbert Wertheim College of Medicine, Miami, Florida. J.B. Warren is assistant professor of pediatrics, Oregon Health & Science University School of Medicine, Portland, Oregon. A. Hyderi is associate dean for curriculum and associate professor of family medicine, University of Illinois College of Medicine, Chicago, Illinois. R.E. Drusin is vice dean for education and professor of medicine, Columbia University College of Physicians and Surgeons, New York, New York. J. Moeller is residency program director and assistant professor of neurology, Yale School of Medicine, New Haven, Connecticut. M. Rosenfeld is senior associate dean for medical education and associate professor of cell biology, New York University School of Medicine, New York, New York. P.R. Orlander is associate dean for curricular affairs, vice chair for education, and professor of internal medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas. S. Yingling is associate dean for educational planning and quality improvement and assistant professor of medical education, University of Illinois College of Medicine, Chicago, Illinois. She was manager, Division of Education Quality, Institute for Innovations in Medical Education, New York University School of Medicine, New York, New York, at the time this work began. S. Call is associate chair for education, residency program director, and professor of medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia. K. Terhune is residency program director and associate professor of surgery, Vanderbilt University School of Medicine, Nashville, Tennessee. J. Bull is lead specialist in competency-based learning and assessment, Association of American Medical Colleges, Washington, DC. R. Englander is associate dean for undergraduate medical education, University of Minnesota Medical School, Minneapolis, Minnesota. D.P. Wagner is associate dean for undergraduate medical education and professor of medicine, Michigan State University College of Human Medicine, East Lansing, Michigan.
Problem:
To better prepare graduating medical students to transition to the professional responsibilities of residency, 10 medical schools are participating in an Association of American Medical Colleges pilot to evaluate the feasibility of explicitly teaching and assessing 13 Core Entrustable Professional Activities for Entering Residency. The authors focused on operationalizing the concept of entrustment as part of this process.
Approach:
Starting in 2014, the Entrustment Concept Group, with representatives from each of the pilot schools, guided the development of the structures and processes necessary for formal entrustment decisions associated with students' increased responsibilities at the start of residency.
Outcomes:
Guiding principles developed by the group recommend that formal, summative entrustment decisions in undergraduate medical education be made by a trained group, be based on longitudinal performance assessments from multiple assessors, and incorporate day-to-day entrustment judgments by workplace supervisors. Key to entrustment decisions is evidence that students know their limits (discernment), can be relied on to follow through (conscientiousness), and are forthcoming despite potential personal costs (truthfulness), in addition to having the requisite knowledge and skills. The group constructed a developmental framework for discernment, conscientiousness, and truthfulness to pilot a model for transparent entrustment decision making.
Next Steps:
The pilot schools are studying a number of questions regarding the pathways to and decisions about entrustment. This work seeks to inform meaningful culture change in undergraduate medical education through a shared understanding of the assessment of trust and a shared trust in that assessment.
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